The Expressionless Face


Self-confidence is an issue for everyone; there is always a feature you wish you could change. Do you want a smaller nose, longer legs, more defined abs? Cosmetic surgery is becoming increasingly popular, with around 27,000 people in the UK undergoing a procedure in 2019. One of the most popular procedures is Botox, but what does this mean?

Although Botox is often associated with fewer wrinkles,  it is used to treat a range of health issues including chronic migraines, eyelid spasms, overactive bladders, incontinence, stiffness of muscles and excessive underarm sweating. Botox was first used medicinally in the 1970s and was unavailable cosmetically until 1990.

Derived from the bacteria Clostridium botulinum, Botox is a neurotoxic protein that prevents nerve activity in the muscles, resulting in targeted muscle paralysis. Whilst you may not recognize C. botulinum by name, this bacterium is present in a variety of settings from soils and lakes to within the intestinal tracts of mammals. There are many commercial preparations of the Botulinum toxin, but Botox is the most common and is known as OnabotulinumtoxinA.

Our nervous systems are complex structures that are easily damaged and altered. Neurotoxins are one example of how we can alter how our nerves communicate. Many nerves within our body will produce acetylcholine (a neurotransmitter) to relay messages to other cells and muscles; these nerves are known as cholinergic neurones. Acetylcholine is crucial for muscle movement, as well as having a key role in learning, memory and mood. The botulinum toxin type A binds to cholinergic neurones and prevents the release of acetylcholine. The toxin is engulfed by the neurone via a process called endocytosis and then separately packaged inside a bubble to prevent it spreading out. Once the toxin is inside the neurone, it will affect other proteins within the neurone, and prevent the release of acetylcholine. This prevents signalling between cells, so muscles do not contract. Muscles are now relaxed and in a state of paralysis. This explains why people with Botox often have a blank expression – their muscles are unable to contract and their forehead is ‘frozen’.

Similar to other procedures, both medicinal and cosmetic, Botox comes with side effects. Not everyone will experience a side effect and the severity varies. One of the largest concerns is that Botox has the potential to migrate through the body from where it was initially injected. As a neurotoxin, this could cause devastating effects on the nervous system, preventing the function of other important muscles. More common side effects include muscle weakness around the injection site, blurred vision, bruising or redness where the injection was administered, and muscle stiffness. Anxiety is another side effect often overlooked. Acetylcholine is a neurotransmitter that has a role in controlling our moods; research has shown an increase in acetylcholine levels can have anti-anxiety effects. Botox decreases levels of acetylcholine, however, this side effect is temporary.

Disclaimer: If you are considering any cosmetic surgery, please consult a medical specialist beforehand and thoroughly research the procedure.



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